1. Group Therapy for People with ID/MI
Robert J. Fletcher, DSW, ACSW
CEO, NADD
(National Association for the Dually Diagnosed)
January 24, 2006
Phoenix, Arizona

2. Consideration in Forming A Group
Homogeneous vs. Heterogeneous
Open vs. Closed
Time Limited vs. Ongoing
Selecting Members
Group Facilitator(s)
Size of Group
Confidentiality Issues
Dr. Fletcher, 2006

3. Homogeneous vs. Heterogeneous
Homogeneous Groups
Members have similar problem(s)
Mutual support based on common problem(s)
Group cohesion can develop easily
Membership derived from mutual problem(s)
Examples
 Women’s Issues & ID  Bi-Polar & ID
 Substance Abuse & ID  Grieving Adults
 Adolescents & ID
Dr. Fletcher, 2006

4. Homogeneous vs. Heterogeneous
Heterogeneous Groups
 Members have different problem(s)
 Members are at different life stages
 Add diversity
 Adds depth to the group dynamics
Examples
 Adults with ID and MI
 Group with sheltered workshop members who
have ID
Dr. Fletcher, 2006

5. Open vs. Closed Groups Open Groups Closed Group
 Membership changes
 New members enter as others leave
 Micro sin of the way life really is
 New group dynamic with each change in membership
Closed Group
 Not open to new members
 Usually runs for a set period of time
 Provides miniscule of safety and security
 Promotes group cohesion
Dr. Fletcher, 2006

6. Time Limited vs. Ongoing
Set number of session
Clear course of beginning, middle and termination stages
Usually appropriate for homogeneous
Closed Group
Not open to new members
Usually runs for a set period of time
Provides miniscule of safety and security
Promotes group cohesion
Dr. Fletcher, 2006

7. Selecting Members Homogeneous vs. heterogeneous
Location and availability
Readiness
Minimum level of interpersonal skills
Motivation for treatment
Basic ability to relate to and be influence by others
Goals
General group goal Individual goal
Interview potential group members
Dr. Fletcher, 2006

8. Group Facilitator(s) Facilitates Interactions Active Leader
Encourages Interaction
Active Leader
Establishes Ground Rules
Accepting Individual
Warming, Caring
Multiple Rules
Therapist Teacher Role Model
Two Facilitators are the Ideal
One Male/One Female
Dr. Fletcher, 2006

9. Size of Group How Large Should a Group Be? Variables
Depends on Purpose of the Group
Single Facilitator or two Facilitators
Six to ten Members
Six for Single Facilitator
Ten for ten facilitated group
Dr. Fletcher, 2006

10. Confidentiality Issues
What a person reveals in group must not be disclosed outside the group
Confidentiality must be a ground rule
Members can and should talk about themes/topics with significant others, but members must comply with:
Preserve anonymity of members when referring to them
Mask details of what was revealed by making them general rather than specific
Share their own reaction to what was revealed, not what was already revealed
Dr. Fletcher, 2006

11. THERAPEUTIC EFFECTS OF GROUP THERAPY
HELPS DECREASE FEELINGS OF: INADEQUACY, ISOLATION AND DEFEAT
PROMOTES PEER SUPPORT
FOSTERS A SENSE OF SECURITY
PROMOTES GROUP COHESIVENESS
ESTABLISHES SENSE OF TRUST
Dr. Fletcher, 1984

12. THERAPEUTIC EFFECTS OF GROUP THERAPY
FOSTERS MEANINGFUL RELATIONSHIPS
INCREASES RELATIONSHIP SKILLS
PROMOTES PROBLEM SOLVING SKILLS
ENABLES LEARNING THROUGH OBSERVATION
Dr. Fletcher, 1984

13. Typical Model
Interactive Model
Tomasulo, 1998

14. Group Therapy Action Method Techniques
Founder: Dr. J. Moreno (psychiatrist)
Technique: Psychodrama (Moreno, 1921)
“refers to an enactment involving
problem-solving in terms of one
person’s conflict.”
The drama (problem-solving) may shift among the many facets of one’s life –
Past, present, and future
Blatner, 1973

15. Group Therapy Action Method Techniques
The Protagonist and Double
Technique used to explore a problem presented by a group member
Protagonist
Person who expresses problem in group
- Interpersonal conflict
- Intrapsychjc conflict
Blatner, 1973

16. Group Therapy Action Method Techniques
2. Double (alter ego or auxiliary ego)
Person who reflects the feelings/experiences of the protagonist
- Expresses the feelings
of the protagonist
- Approximates the emotional state of
protagonist
Blatner, 1973

17. Group Therapy Action Method Techniques
Five Therapeutic Purposes of the Double:
Provides emotional support
Gives emotional expression
Reorganizes perceptions
Promotes empathy
Sets the stage for entharsis
Opportunity for change is enhanced if the protagonist feels supported and understood as expressed by the double
Blatner , Tomasulo

18. Group Therapy Action Method Techniques
Choosing the Double:
Facilitator can choose
Protagonist can choose
Group member can volunteer
Facilitator can be double
Protagonist can double
Tomasulo, 1998

19. Group Therapy Action Method Techniques
Processes and Techniques Used in Doubling
Restarting (to demonstrate understanding of protagonist)
Speaking the unspoken (to express what protagonist feels but cannot say)
Exaggerating (to assert loudly what protagonist presents timidly)
Amplifying (to highlight key parts of protagonist’s statements)
Razza and Tomasulo, 2005

20. Group Therapy Action Method Techniques
Processes and Techniques Used in Doubling (continued)
Verbalizing the resistance (to clarify impediments to therapeutic change)
Clarifying conflict (to voice competing emotions or ambivalence)
Introducing alternatives (to voice ways to reframe protagonist’s perception of self or situation)
Note: The member doubling checks accuracy of each doubled statement with protagonist; protagonist may repeat key statements.
Razza and Tomasulo, 2005

21. Group Therapy Action Method Techniques
Role of Facilitator
Facilitate group interaction
Facilitates interaction between protagonist
- asking the double how protagonist feels
- checking with protagonist on expressions from the double
Facilitator may need to role model both roles
4. Suggest that “I” statement be used
- I feel ……
Tomasulo, 1998

22. THE INTERACTIVE BEHAVIORAL MODEL OF GROUP THERPAY (IBT)
STAGE 1: ORIENTATION
STAGE 2: WARM-UP
STAGE 3: ENANCTMENT
STAGE 4: AFFIRMATION
Tomasulo, 1998

23. THE INTERACTIVE BEHAVIORAL MODEL OF GROUP THERPAY (IBT)
STAGE 1
ORIENTATION AND COGNITIVE NETWORKING
OBJECTIVE
FACILITATE GROUP INTERACTION
TECHNIQUES
PHYSICAL WARM-UP
DISCUSS THEIR MORNING
HAVING MEMBERS REPEAT WHAT WAS SAID
Tomasulo, 1998

24. THE INTERACTIVE BEHAVIORAL MODEL OF GROUP THERPAY (IBT)
STAGE 2
WARM-UP FOR ENACTMENT AND SHARING
OBJECTIVE
PROMOTE GROUP PROCESS
TECHNIQUES
SELF DISCLOSURE AND TAKING TURNS
BRINGING GROUP TOGETHER (GROUPNESS)
MEMBERS ASKING OTHERS TO SPEAK
Tomasulo, 1998

25. THE INTERACTIVE BEHAVIORAL MODEL OF GROUP THERPAY (IBT)
STAGE 3
ENACTMENT
OBJECTIVE
PROBLEM SOLVING AND GROUP INTERACTION
TECHNIQUES
ACT OF POSSIBLE ROLE PLAYED BY ANOTHER GROUP MEMBER AS HE/SHE GIVES VOICE TO THE FEELINGS AND THOULGHTS OF ANOTHER
EMPY CHAIR
ROLE REVERSAL
Tomasulo, 1998

26. THE INTERACTIVE BEHAVIORAL MODEL OF GROUP THERPAY (IBT)
STAGE 4
AFFIRMATION
OBJECTIVE
VALIDATION OF PARTICIPATION
TECHNIQUES
REINFORCEMENT THERAPEUTIC INTERACTIONS
MEMBER ACKNOWLEDGEMENT OF PARTICIPATION
DECOMPRESS FROM GROUP EXPERIENCE AND SIGNAL CLOSURE OF GROUP SESSION
Tomasulo, 1998

27. FOR MORE INFORMATION CONTACT
Dr. Robert J. Fletcher
NADD (The National Association for the Dually Diagnosed)
132 Fair Street, Kingston, NY 12401
Telephone
Thank you!
2006